MEDICARE: SAMANTHA KAY COLON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033647656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA KAY COLON

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5035
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 MAGUIRE RD STE 200
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4750
Country	:	US
Telephone Number	:	407-602-5010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2017
Last Update Date	:	10/19/2022

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Directions to “ SAMANTHA KAY COLON ” Practice Location

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